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How often do you recommend bone scans/MRI for stage IV prostate patients who are asymptomatic? How beneficial is this?

Bone scans and other radiographic tests including CT and MRI scan are used to detect spread of prostate cancer. The results of these tests are an important part of decisions about when to start treatment and when to make subsequent changes in therapy.

The standard of care for men with bone metastases is hormone therapy and few men with known bone metastases would be followed without treatment. In men receiving hormone therapy for bone metastases, I recommend repeat bone scan when the PSA begins to rise or there is other evidence that the cancer is worsening.

In some cases, the prostate cancer makes little or no PSA and the PSA test is an unreliable marker for the disease. In these rare cases, I recommend bone scans every year even if the PSA remains low and there are no new symptoms to suggest bone metastases.

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